Provide Peer Support Research Articles

Barriers and Facilitators to User Engagement and Moderation for Web-Based Peer Support Among Young People: Qualitative Study Using the Behavior Change Wheel Framework

Background Peer support groups or web-based chats for young people offer anonymous peer support in judgment-free spaces, where users may share their thoughts and feelings with others who may have experienced similar situations. User engagement is crucial for effective web-based peer support; however, levels of engagement vary. While moderation of peer support groups can have a positive impact on the engagement of young people, effective moderation can be challenging to implement. Objective This study aimed to identify barriers and facilitators to user engagement with, and moderation of, web-based peer support groups among young people aged 16 to 25 years and to provide recommendations for enhancing this service. Methods Drawing upon the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW), this study conducted qualitative interviews and gathered open-ended questionnaires from service users and moderators of The Mix, the United Kingdom’s leading web-based mental health platform providing peer support groups for young people. Semistructured interviews were conducted with 2 service users and 8 moderators, and open-ended questionnaires were completed by 7 service users. Themes were coded using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and the TDF. The BCW tools were then used to identify relevant behavior change techniques to improve user engagement in, and moderation of, the service. Results Thematic analysis revealed a total of 20 inductive themes within 10 TDF domains—9 (45%) for engagement and 11 (55%) for moderation. Of these 20 themes, 3 (15%) were facilitators of engagement, 7 (35%) were facilitators of moderation, 4 (20%) were barriers to moderation, and 6 (30%) barriers to engagement. Results suggest that skills, knowledge, beliefs about consequences, intentions, emotions, and the social and physical environment are important factors influencing service users and moderators of group chats. In particular, supporting the improvement of memory, attention, and decision-making skills of those involved; adapting the physical environment to facilitate effective interactions; and reducing negative emotions are suggested to optimize the value and effectiveness of peer support groups for young people’s mental health for both the service users and moderators of these services. Conclusions The study demonstrates the effectiveness of the BCW approach and the use of the TDF and COM-B model to understand the influences on behavior in a systematic manner, especially for mental health and well-being interventions. The findings can be applied to design structured interventions to change behaviors related to the engagement with, and moderation of, web-based peer support groups and, in turn, improve mental health outcomes for young people.

Bringing Young People, Health and Social Care Professionals, Transition Champions and Policymakers Together Through Hybrid Methods of Participation: Creating a Space for Shared Understanding of What Is Required to Improve Young People's Healthcare Transition.

A multi-stakeholder conference was held in 2023, celebrating the achievements of the Burdett National Transition Nursing Network (BNTNN). The BNTNN had been implemented across England in 2020 to map the current state of young people's healthcare transition into adult services across England, andwork with key stakeholders to coach them through making sustainable quality improvements to young people's transition services. This work was funded by the Burdett Trust for Nursing, following the success of an exemplar Model for Quality Improvement (QI) for Transition, which had been developed at a Teaching Hospital in England. The BNTNN consisted of a National Lead Nurse, four Regional Nurse Advisors based in host organisations in the four main regions of England, and an Expert Advisor for the care of young people. A research team was appointed to evaluate the impact of the BNTNN, leading the National Transition Evaluation Study. The BNTNN Lead Nurse worked in partnership with NHS England to provide national solutions to high-level barriers to the implementation of transition pathways. Young people with long-term conditions have participated and engaged with the BNTNN since its inception, throughout the QI project and research through membership to the Transition Advisory Group. Young people, professionals, staff members and policymakers were included in our hybrid conference in March 2023. The BNTNN and research team brought these groups together to share learning from the 3-year project, celebrating and showcasing achievements in each region as a result of the expert advice and support from the network. Young people contributed their experiences of transition journeys into adult services, and policymakers reflected upon national developments. Provider organisations from each region showcased their transition transformation journeys, sharing successes and challenges encountered during the QI process. The research team provided an update, and was responsible for capturing content and discussions on the day. With 405 attendees, the conference provided peer support and guidance, and enabled connections between young people, health and social care professionals, transition champions and policymakers. The primary aim was to forge long-lasting collaborations for the benefit of improving health services and outcomes for young people. In this article we highlight how it is possible to bring key stakeholders together through hybrid methods of participation, and how this enabled a shared understanding and a combined commitment to progress young people's transition services for the future. Young people who are experts by experience have been involved throughout this 3-year project and in the ongoing evaluation. Here we highlight the importance of involving young people, professionals, staff members and policymakers when creating a space for shared understanding of what is required to improve services for young people transitioning into adult healthcare services. NCT05867745 [ClinicalTrials.gov].

Phenomenological Description of the Experiences of Teenagers With Critically Ill Parents.

Critical illness not only threatens the life of the patient but also may profoundly impact the lives of their loved ones. For teenagers with a critically ill parent, these impacts may have significant, developmentally impactful effects. A descriptive understanding of these effects may advance scholarly understanding of the challenges these teenagers face. In this study, we sought to understand this overlooked population, i.e., teenagers with a critically ill parent, using a descriptive analysis of their experiences. Individual and group interviews were conducted with the participants (n = 9). Interviewers presented standardized semistructured interview questions to all of the participants. The questions explored situational, emotional, relational, and dynamic phenomena related to the experience of having a critically ill parent. Themes describing the participants' lived experiences related to having a parent with a critical illness were examined using a three coding framework. Four themes emerged, including parental health interference on teenagers-fallout, worsening, and interference; emotional experience and how emotions were processed-emotions, cognitive strategies, and behavioral strategies; relationships with others-sharing feelings, company, and relationships; and information and secrecy-learning, secrecy, and history. All of the teenagers in this study were found to suffer from both situational and emotional interference. Parentification, use of selective distraction as an emotion regulation skill, and reliance on support from others were also observed. These results shed light on the overall experience of teenagers who have a critically ill parent. The fallout effects of a parent's health can encompass situational, logistical, emotional, and relationship aspects. Importantly, attention must be paid to how teenagers cope with the emotions experienced during a parent's critical illness. This framework may inform how to more effectively support teenagers through strategies such as providing peer support opportunities.

Identifying 'Where' and 'How' Peer Support for Youth is Integrated into Community-Based Mental Health Services: A Survey Study.

To mitigate barriers to care among youth (12-25years), community-based organizations have increasingly integrated peer support as a complement to clinical mental health care; however, information regarding the integration process is lacking. To explore organizational perspectives regarding the contexts and mechanisms underlying integration of peer support for youth accessing mental health services from community-based, youth-serving organizations. Representatives from community-based youth-serving organizations completed a survey describing the contexts in which they are located and their experiences integrating peer support. Text responses were analyzed using directed content analysis. 21 organizations serving youth aged 11-29years responded. Three generic categories were identified: 1) Context is key and safe environments, 2) Supportive organizations and valuing lived experience, 3) Benefits for peer support providers and receivers and purposeful integration into the organization. Peer support integration requires valuing of the lived experience of peers and creation of a safe organizational environment.

Examining the Emotional and Physical Health Impact in Users of Open-Source Automated Insulin Delivery and Sources of Support: Qualitative Analysis of Patient Narratives.

Although commercially developed automated insulin delivery (AID) systems have recently been approved and become available in a limited number of countries, they are not universally available, accessible, or affordable. Therefore, open-source AID systems, cocreated by an online community of people with diabetes and their families behind the hashtag #WeAreNotWaiting, have become increasingly popular. This study focused on examining the lived experiences, physical and emotional health implications of people with diabetes following the initiation of open-source AID systems, their perceived challenges, and their sources of support, which have not been explored in the existing literature. We collected data from 383 participants across 29 countries through 2 sets of open-ended questions in a web-based survey on their experience of building and using open-source AID systems. Narratives were thematically analyzed, and a coding framework was identified through iterative alignment. Participants consistently reported improvements in glycemia, physical health, sleep quality, emotional impact on everyday life, and quality of life. Knowledge of open-source AID systems was largely obtained through the #WeAreNotWaiting community, which was also the primary source of practical and emotional support. The acquisition of the components to build an open-source AID system and the technical setup were sometimes problematic. The #WeAreNotWaiting movement represents a primary example of how informed and connected patients proactively address their unmet needs, provide peer support to each other, and obtain results through impactful, user-driven solutions. Alongside providing evidence on the safety and efficacy of open-source AID systems, this qualitative analysis helps in understanding how patients' experiences and benefits range from psychosocial improvements to a reduction in the burden of managing diabetes. RR2-10.2196/15368.

The influence of nursing handover on nurses' mental health: A scoping review

<p>Nursing handover is essential in clinical practice across various healthcare settings and can significantly impact nurses' mental health. This scoping review aimed to explore and map these implications using the JBI methodology and PRISMA ScR Checklist. It included 11 studies published between 1988 and 2022 from the UK, Australia, USA, South Korea, and Hong Kong, involving over 122 nurses in acute care settings. The findings reveal three major themes: source of psychological discomfort, coping resource, and peer support and cohesion. Negative emotions such as stress, anxiety, dissatisfaction, and tension are linked to handovers, particularly bedside handovers, which raise confidentiality issues and induce scrutiny among nurses. The lack of standardized training and consistent procedures also contributes to stress, especially for newly graduated and less experienced nurses. Conversely, handovers function as structured rituals providing peer support and a sense of control, helping nurses manage psychological demands. To mitigate negative impacts, implementing standardized handover procedures and comprehensive training programs for new nurses is essential. Encouraging open communication and fostering a supportive environment can enhance team cohesion and reduce stress. Future research should measure the impact of different handover practices on nurses' mental health and explore their supportive, social, protective, and restorative functions. This review highlights the critical role of nursing handovers in supporting nurses' mental health and underscores the need for standardized practices to improve the well-being of nursing professionals and the quality of patient care.</p>

Consolidated Newborn Bloodspot Screening Efforts in Developing Countries in the Asia Pacific-2024.

Approximately half of all births globally occur in the Asia Pacific Region. Concerted efforts to support local activities aimed at developing national newborn screening (NBS) have been ongoing for almost 30 years, first by the International Atomic Energy Agency (IAEA) and then through volunteer efforts. Sustainable newborn bloodspot screening (NBS) continues to be initiated and develop in many of the countries with developing economies in the region. Since the discontinuation of IAEA funding in 2007, a working group of the Asia Pacific Society of Human Genetics (APSHG) consisting of interested representatives from countries in the region with less than 50% NBS coverage has participated in periodic workshops to exchange information, set goals, and provide peer support. Facilitated by international NBS experts, interested corporate sponsors, and the APSHG, the 7th workshop of representatives from 10 East Asian countries with developing NBS systems was recently held in Kathmandu, Nepal. This report summarizes the NBS activities in these countries and describes the continuing efforts to move NBS ahead in the region.

Advancing peer support workforce research: Insights and recommendations through the lens of professionalization.

Over the past two decades, peer support providers have increasingly formalized their roles in the addiction treatment workforce through credentialing and professionalization efforts. Despite these advancements, misconceptions regarding their professional identity persist and contribute to challenges such as burnout and high turnover. This commentary underscores the importance of viewing the peer workforce as an emerging profession using a lens that has previously been applied to other healthcare service roles. We outline key milestones in the peer workforce's professional development and ongoing labor advocacy efforts by state and national organizations. We call for a comprehensive research agenda that addresses workforce outcomes, workplace dynamics, and role competencies. Such efforts are crucial for advancing the recognition and support of peers as an integral component of the behavioral healthcare workforce.

The RISE (Resilience in Stressful Events) Peer Support Program: Creating a Virtuous Cycle of Healthcare Leadership Support for Staff Resilience and Well-Being.

Healthcare leaders are responsible for creating an environment where their staff can maintain their resilience and well-being. However, there is a crisis of burnout among healthcare workers. The resulting increased turnover, diminished morale and performance, safety risks, and decreased worker engagement produces a vicious cycle of burnout. A strategic intervention is needed that focuses on worker wellbeing. This paper describes how the Johns Hopkins Resilience In Stressful Events (RISE) peer support program has helped healthcare leaders support their workers and strengthen the resilience of their organization. It explains the crucial role that leaders play in the success of the program. RISE peer was established at Johns Hopkins Hospital in 2011 to provide timely peer support for stressful patient and work-related situations. RISE helps break the cycle of healthcare worker burnout by providing peer support for stresses at work 24hours a day, 7 days a week. This program structure also supports leaders by sharing the responsibility of emotional support and by providing them with new skills to do their job in a way that generates personal and professional satisfaction. The program has been implemented globally in over 140 healthcare organizations. Leaders are essential to integrate support and serve as role models. Institutions that successfully launch peer support programs engage leaders to participate in program design, participate in the program themselves, and adapt the program to meet the needs of their staff and organization. Peer support programs broaden the base of support for all healthcare workers by providing an employee-focused resource. Implementation of a RISE support model demonstrates an institution's commitment to the overall health of the people it employs. Operational integration of the model conveys a positive impact on resilience at all levels of the organization, especially in institutions that broadly engage organizational leaders.

Young people’s sense of agency and responsibility towards promoting mental health in Brazil: a reflexive thematic analysis

ObjectivesThis study investigated how Brazilian young people perceive their role in promoting and supporting their peer community’s mental health and well-being, and the conditions and contexts influencing their engagement.DesignCo-produced qualitative...

Countermeasures and follow-up actions in response to information on thyroid cancer, which possibly provoked misunderstanding and unfounded rumour, issued by five former Japanese prime ministers.

This study summarises the responses to information on thyroid cancer, which possibly provoked misunderstanding and unfounded rumour, described in a letter issued by five former Japanese Prime Ministers on 27 January, 2022. Fukushima Medical University (FMU) implemented countermeasures and follow-up in three phases in response to the letter. In Phase 1, FMU shared scientific facts on the relationship between radiation exposure and thyroid cancer, as well as the response of FMU towards those who read the letter and were concerned about the description. Furthermore, FMU organised lectures and workshops to facilitate peer support among medical and non-medical staff, which were publicised through a newspaper article. In Phase 2, the peer support programme targeting patients with thyroid cancer was launched. In Phase 3, FMU participated in a TV programme to explain the medical aspects of thyroid cancer and the importance of providing peer support to patients with cancer, featuring individuals with experiences as medical staff and survivors.

QOL-13. FROM SURVIVING TO THRIVING WITH A BRAIN TUMOR: THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO NEUROONCOLOGY MODEL FOR AN EMPOWERED AND ENGAGED PEER VOLUNTEER SUPPORT COMMUNITY

Abstract BACKGROUND Brain tumor patients often experience feelings of isolation, identity loss, and existential distress, and peer support can have a positive impact in these areas. Providing peer support, however, can be emotionally demanding and presents unique challenges for neuro-oncology patient volunteers, with little guidance available to address these issues. We describe an innovative program that supports volunteers and provides a roadmap for implementing peer volunteer programs in clinical neuro-oncology practices. METHODS In 2020, the UCSF Sheri Sobrato Brain Cancer Survivorship Program established an initiative to match brain tumor patients seeking support with trained patient volunteers. To address potential challenges, an optional, ongoing support community for volunteers was created by a health coach educator, with co-facilitation from a rehabilitation neuropsychologist and a social worker. The weekly meetings included supplemental training, personal check-ins, and group discussions. Volunteer feedback was collected through direct volunteer communication with the facilitator and an annual online survey. RESULTS From August 2020 through October 2023, 46 peer volunteers were trained in six cohorts. There were 116 patients requesting peer support. In total 132 volunteer-patient matches were made for an average of 2.87 matches per volunteer. Seventy percent of volunteers attended 11 or more meetings/year. Average attendance was 12 volunteers per meeting. All respondents to the annual online survey (n=31) reported a high level of satisfaction with the program. Volunteers highlighted benefits such as mutual support, impactful contributions, and personal growth and empowerment. Volunteers who reported higher levels of preparedness attended >11 meetings per year. DISCUSSION In our experience, patient peer volunteer programs show promise in reducing isolation and restoring purpose. This unique 3-year pilot suggests that ongoing group support and training is a plausible and effective way to enhance a peer volunteer program. Future efforts will focus on developing a structured curriculum for neuro-oncology patient peer volunteers.

Peer mentors’ experiences of delivering peer support for individuals with eating disorders: giving back and supporting processes of change

ABSTRACT Peer support is a promising approach to increasing hope, engagement, and connection for those with eating disorders (EDs). Emerging literature explores peer mentors’ experiences of providing support, suggesting that mentors often benefit from providing peer support, particularly when well trained and supervised. We conducted semi-structured interviews or focus groups with 15 individuals providing peer support (one-on-one, group, or chat) to individuals with EDs. We identified 3 themes using reflexive thematic analysis (RTA) through a critical realist lens. Participants emphasized the importance of ongoing training and support to help them deliver high-quality peer support. They highlighted the importance of value-alignment in this work in terms of organizational valuing of lived experience and alignment with social justice. Participants reflected on how doing this work contributed to a sense of “giving back” and providing the kind of support they wished they had experienced. Providing peer support was described as emotion work; a challenging and rewarding experience for peer mentors. Findings carry implications for integrating peer support into the continuum of care for EDs, providing insight into approaches that can support peer support delivery in a way that promotes safety for those providing and receiving it.

A novel approach to peer support for academic researchers.

Academic researchers experience high levels of stress, isolation and loneliness, which compromise their well-being. There is a particular need to address these issues amongst early career and postgraduate research staff. 'Spaces for Listening' is an initiative to increase active listening and provide peer support. To assess the feasibility, acceptability and potential impacts of Spaces for Listening in an academic setting. Early career and postgraduate researchers from a large university in the UK were invited to attend 'Academic Spaces for Listening' (ASfL). Five ASfL sessions (including in-person and Chinese language) were held. A mixed-methods study using online survey and in-depth interviews was conducted. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using principles of thematic analysis. The qualitative and quantitative findings were integrated at the interpretation phase. A total of 25 participants attended an ASfL session, 22 of them completed the survey and 6 participants participated in semi-structured interviews. Participants were very satisfied with the session content (68%, n = 15), organization (68%, n = 15) and delivery (68%, n = 15). Four themes were identified from qualitative analysis: (i) the 'Academic Spaces for Listening' (ASfL) experience; (2) impact of ASfL; (3) potential challenges of ASfL and (4) ASfL in the future. Interpersonal connectedness was an important outcome for participants during the session. Participants showed interest in the future of ASfL. Implementing Spaces for Listening in an academic setting is feasible and was well received by participants. The initiative may fill a gap in the social interactions amongst academic researchers.

Understanding the extent of caregiver involvement and needs in treatment-impacting activities.

187 Background: Caregivers are known to be a significant part of patient care; however, the extent of their role is commonly underestimated and they often feel ‘invisible’. COLONTOWN (CT) is a virtual colorectal cancer community providing peer support and evidence-based education for both caregivers and patients. As such, we sought to understand caregivers’ involvement related to treatment decision making and care delivery, and related gaps in support. Methods: Our online anonymous survey was posted in May 2024 to members of CT’s international caregiver community, who may be more active in their patients’ care than typical of the broader CRC population. It included 33 questions on caregiving responsibilities, effect of cancer on other life activities, impacts, support received/needed and 13 demographic questions. We identified a subset of 9 questions specifically related to treatment that are reported here. Results: All data was self-reported based on their patient’s time in active treatment. Of 359 respondents, 88% were female and 86% significant others/spouses. Their patients were 90% Stage IV and 85% in the US with 17 other countries represented. Caregivers nearly always participate in and often have primary responsibility in treatment-impacting activities (Table). This includes researching treatment options, where among the 69% in a primary role 31% have complete responsibility, managing side effects, and recording and reporting symptoms. 88% were always or usually at appointments and/or otherwise in direct contact with the care providers. Caregivers' roles, however, are not always recognized by their patient’s care team. Only 6% felt completely supported and 21% felt completely respected by their patient’s care team. 66% felt “Enhanced communication and collaboration with healthcare providers” would aid in their role in patient care. 56% indicated “more education resources for caregivers” are needed. Conclusions: Caregivers report assuming primary responsibility in many critical activities in patient treatment. The gap in recognizing this dynamic contributes to the challenges of caregiving. CT embraces the vital role of caregivers by offering dedicated caregiver resources and engaging them as equal partners in development and offering of all programs . Acknowledgement of the depth of the caregiver role is needed and more caregiver support should become a standard component of the patient’s care plan. Any shared decision-making processes and education should appropriately recognize and include caregivers as critical stakeholders as requested by their patient. Caregivers’ reported role in treatment-impacting caregiving activities. Activity Primary Role % Split Evenly % Support Role % No Role % Researching treatment options 69 13 17 1 Researching/managing side effects 64 21 14 1 Symptom reporting 47 24 23 6 Coordinating care 44 27 25 4

The spinal cord injury (SCI) peer support evaluation tool: the development of a tool to assess outcomes of peer support programs within SCI community-based organizations

Study designGuided by the 4-step process outlined in the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, multiple methodologies were used: Delphi, literature reviews, ratings with consensus, think-aloud, and test-retest.ObjectivesThe purpose of this study was to develop and test a spinal cord injury (SCI) peer support evaluation tool that meets the needs of community-based SCI organizations in Canada.SettingPeer support programs for people with SCI delivered by community-based SCI organizations.MethodsThis research was co-constructed with executives and staff from SCI community-based organizations, people with SCI, researchers, and students. Given the multiple steps of this study, sample size and characteristics varied based on each step. Participants included people with SCI who received peer support (mentees) or provided peer support (mentors/supporters) and staff of community-based organizations.ResultsIn step 1, the 20 most important outcomes for SCI peer support were identified. In step 2 and 3, the 97 items were identified to assess the outcomes and by using rating and multiple consensus methodologies 20 items, one to assess each outcome, were selected. In step 4, content and face validity and test-retest reliability were achieved. The resulting SCI Peer Support Evaluation Tool consists of 20 single-item questions to assess 20 outcomes of SCI peer support.ConclusionThrough a systematic process, the SCI Peer Support Evaluation Tool is now ready to be implemented to assess outcomes of SCI peer support programs delivered by community-based SCI organizations.

Individual and organizational outcomes of engaging peers in the cocreation of digital mental health interventions.

Within mental health services, persons in recovery from their own experiences of mental health challenges (peers) are increasingly being trained to provide peer support. This study describes individual and organizational outcomes related to engaging peers in a multisite demonstration project in California that sought to integrate them as cocreators throughout planning and implementation of digital mental health interventions. We collected data from key informants across 11 sites. Quarterly online surveys invited key informants to report perceived outcomes of the peer component. Biannual interviews elicited details regarding survey-reported outcomes. Quantitative data provided indications of outcome prevalence and consistency, and quotes from the interviews illustrated the complex realities underlying survey responses. One hundred three quarterly surveys and 39 biannual interviews were completed between Summer 2020 and Fall 2022. Key informants reported diverse outcomes, including integration of peer input into local decision making, mental health benefits to peers and community members, reduced workplace mental health stigma, and new cross-site collaborations. Five sites reported outcomes with greater consistency compared to the other six sites. Reports of increased peer visibility in the workplace coincided with reports of reduced stigma and increased value of peer input by mental health professionals. This study offers encouragement for the potential positive impact of engaging peers as cocreators of mental health interventions. Data suggest integrating peers does not increase mental health stigma and may instead result in various positive outcomes. The degree to which these outcomes manifest in a specific setting, however, may vary. Future research should seek to identify contextual factors that support actualization of positive outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Caregiver Burden and Mental Health: Millennial Caregivers

Millennials are the next generation of caregivers in the United States, with unique qualities disparate from prior generations. The group is more racially and ethnically distinct, with gender differences varying by race and ethnicity. Research has shown that caregivers of those with mental illness have an increased incidence of depression and anxiety. Current research suggests that targeted interventions for caregivers that promote empowerment, attention to their health concerns, and addressing financial needs can assist in decreasing the risk for adverse health effects associated with caregiving. The National Alliance for Mental Illness (NAMI) program, Family to Family (FTF), is a nationwide free 12-week educational program designed to educate and support caregivers of persons with mental illness. Programs like FTF can assist Millennial caregivers by providing peer support, increasing knowledge about caregiving, and expanding understanding of mental illness. Implications for nursing practice and future research are discussed.

Acceptability, feasibility and preliminary effectiveness of the mHealth intervention, InTSHA, on retention in care and viral suppression among adolescents with HIV in South Africa: a pilot randomized clinical trial

ABSTRACT We describe the results of a pilot randomized clinical trial of a mobile phone-based intervention, InTSHA: Interactive Transition Support for Adolescents with HIV, compared to standard care. Encrypted, closed group chats delivered via WhatsApp provided peer support and improved communication between adolescents with HIV, their caregivers, and healthcare providers. We randomized 80 South African adolescents ages 15 to 19 years with perinatally-acquired HIV to receive either the intervention (n=40) or standard of care (n=40). We measured acceptability (Acceptability of Intervention Measure [AIM]) and feasibility (Feasibility of Intervention Measure [FIM]) as primary outcomes. We evaluated impact on retention in care and viral suppression six months after randomization as secondary endpoints. We performed bivariable and multivariable analyses using logistic regression models to assess the effect of the InTSHA intervention compared to standard of care. Among the adolescents randomized to the InTSHA intervention, the median AIM was 4.1/5.0 (82%) and median FIM was 3.9/5.0 (78%). We found no difference in retention in care or in viral suppression comparing intervention and control groups. Among adolescents who attended three or more sessions, retention in care was 100% at 6 months. InTSHA is an acceptable and feasible mHealth intervention warranting further study in a larger population.

Qualitative Evaluation of an Antimicrobial Stewardship Tele-Mentoring Program in US Rural & Critical Access Hospitals

Background: The University of Washington (UW) Center for Stewardship in Medicine (CSiM) supports a tele-antimicrobial stewardship (AMS) program (TASP) using the ECHO approach (Extension for Community Healthcare Outcomes) in small, rural, and Critical Access Hospitals (primarily in the western U.S.) with education, mentoring, organizational capacity building, and a community of peers. To evaluate the continuing education (CE) component of UW-TASP ECHO, CSiM surveyed individuals receiving CE credits as part of the program. This survey was designed to track individuals’ satisfaction with the program and to assess the impact of UW-TASP ECHO on AMS in participating facilities. Methods: The CE participants’ survey was completed annually by individuals participating in UW TASP ECHO using online survey software. The survey included closed-ended and open-ended questions. Responses to open-ended questions were entered into Atlas.ti qualitative analysis software and coded iteratively according to themes that emerged. When a new code emerged partway through the coding process, earlier surveys were re-coded for the new code. Final codes were grouped into themes and sub-themes and quotes from each theme identified were summarized and attached to the theme and reported. Results: Data from three administrations of this survey were available: 2018-2019 (n=66); 2020-2021 (n=27); and 2021-2022 (n=30). These surveys were completed by a total of 95 individuals from 53 hospitals. Seven of these individuals completed a survey in each year, 14 completed a survey in two years, and 74 completed only one survey. Themes identified were COVID-19 support (including procedures and policies, being kept up-to-date, research summaries, and peer support), the antibiotic pocket guide developed by UW, strength in community, staff education, role of CSiM in developing/strengthening the AMS program at the facility, change in use of antibiotics, UW imprimatur, learning/growing as a healthcare provider, and importance for small, rural hospitals (see examples in Table 1). Conclusions: This qualitative analysis provides evidence from surveys of individuals participating in CE that UW TASP ECHO has had a meaningful impact in such domains as building a strong community among small, rural and critical access hospitals, educating staff, changing antibiotic use and providing peer support, among others.